Cancer Treatments

Stage II — The cancer has spread from the body of the uterus to the cervix.

The choice of treatment depends on the size of the tumor, the stage of the disease, whether female hormones affect tumor growth, and the tumor grade. (The grade tells how closely the cancer cells resemble normal cells and suggests how fast the cancer is likely to grow. Low-grade cancers are likely to grow and spread more slowly than high-grade cancers.) The doctor also considers other factors, including the woman’s age and general health.

A woman may want to talk with her doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for women with all stages of uterine cancer. The section on “The Promise of Cancer Research” has more information about clinical trials.

Most women with uterine cancer have surgery to remove the uterus (hysterectomy) through an incision in the abdomen. The doctor also removes both fallopian tubes and both ovaries. (This procedure is called a bilateral salpingo-oophorectomy.)

The doctor may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it may mean that the disease has spread to other parts of the body. If cancer cells have not spread beyond the endometrium, the woman may not need to have any other treatment. The length of the hospital stay may vary from several days to a week

Some women with Stage I, II, or III uterine cancer need both radiation therapy and surgery. They may have radiation before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the area. Also, the doctor may suggest radiation treatments for the small number of women who cannot have surgery.

Doctors use two types of radiation therapy to treat uterine cancer:

External radiation: In external radiation therapy, a large machine outside the body is used to aim radiation at the tumor area. The woman is usually an outpatient in a hospital or clinic and receives external radiation 5 days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation. No radioactive materials are put into the body for external radiation therapy.

Internal radiation: In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The woman stays in the hospital during this treatment. To protect others from radiation exposure, the patient may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, the woman has no radioactivity in her body.

Some patients need both external and internal radiation therapies.

Fortunately, most localized uterine cancers have a high (>90%) cure rate. However, the prognosis is grave for women with metastatic or aggressive forms of uterine cancer. Fewer than 20% of women whose disease has spread into the pelvis will survive five years. “We just don’t have very effective treatments for advanced or recurrent uterine cancers,” said Lois Ramondetta, M.D., an assistant professor in the Department of Gynecologic Oncology at The University of Texas M. D. Anderson Cancer Center.

More than 40,000 women in the U.S. will be diagnosed with uterine cancer in 2004. While most women are 60 years or older at diagnosis, 20% to 25% are premenopausal. “For some reason that we don’t yet understand, we are seeing more women with this disease at a younger age, in their 30s and 40s,” noted Anuja Jhingran, M.D., an associate professor in the Division of Radiation Oncology, whose research focuses on gynecologic tumors. “And one of the other mysteries of the disease is that older women [>70 years] have a poorer prognosis than younger women when compared stage-for-stage. This is unlike many other cancers.”

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Before starting treatment, a woman might want a second opinion about the diagnosis, the stage of cancer, and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the woman requests it. Gathering medical records and arranging to see another doctor may take a little time. In most cases, a brief delay does not make treatment less effective.

There are a number of ways to find a doctor for a second opinion:

The patient’s doctor may refer her to one or more specialists. Specialists who treat women with uterine cancer include surgeons, gynecologic oncologists, medical oncologists, and radiation oncologists. At cancer centers, these doctors often work together as a team.

The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.

People can get the names of specialists from their local medical society, a nearby hospital, or a medical school.

The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors’ names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at. (Click on “Who’s Certified.”)

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I would highly advise getting a second opinion no matter what. First to make sure that this truly is Uterine Cancer. This is rarely diagnosed or seen in young women. Secondly, I would also make sure that it has definitely left the Uterus & entered the Cervix, as that will define much of the surgical options & treatment choices ahead. If the 2nd opinion confirms Stage II Uterine Cancer, most likely pregnancy wouldn’t be an option, due to the surgical removal of the Uterus and any other affected organs.

If that is found to be the case, then I would suggest asking your Dr. about the option of harvesting your eggs and freezing them. A friend of mine did this when she had cancer & then you would have the option of having them fertilized with your husband’s sperm and placed in a surrogate, who would then carry the baby for you. In my friend’s case, all went well & they now have a beautiful 4 year old little girl. All this is a lot to think about at once.

First get a 2nd opinion, then discuss early on with your Dr. his opinions on surrogacy or possible options in your case. You might also want to meet with a Fertility Specialist in your area to get more info on any possibilities with your situation. In the end, remember the most important thing is you getting well. No matter what happens, there are 1000’s of kids available for adoption too, who would love to be part of your family. I hope this info helps answer some questions.